Provider Demographics
NPI:1215190582
Name:WEAVER, ELIZABETH CALDER (OTR L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CALDER
Last Name:WEAVER
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-1426
Mailing Address - Country:US
Mailing Address - Phone:803-245-1757
Mailing Address - Fax:
Practice Address - Street 1:113 OAK ST
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1426
Practice Address - Country:US
Practice Address - Phone:803-245-1757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1864225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist